脑微出血在两种单侧孤立脑桥梗死中比较研究

CMBs between two different types of isolated unilateral pontine infarction:a comparative study

目的比较脑微出血(CMBs)在脑桥旁正中梗死(PPI)和脑桥深部梗死(SDPI)的发生情况,进一步探讨其可能的发病机制。方法回顾性分析2012年10月至2016年6月沈阳军区总医院收治的442例脑桥梗死患者的临床资料。根据纳入及排除标准,筛选出符合条件的单侧孤立脑桥梗死患者110例。其中,PPI患者70例(PPI组),SDPI患者40例(SDPI组)。所有患者均进行入院24 h尿素、肌酐、胱抑素C、总蛋白、白蛋白、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白a、同型半胱氨酸(Hcy)、纤维蛋白原、D-二聚体、空腹血糖、随机血糖、超敏C反应蛋白(h CRP)等检查,结合头磁共振成像(MRI)+经头弥散加权成像(DWI)、头磁共振血管成像(MRA)和头磁敏感加权成像(SWI)检查,观察CMBs的发生情况。结果两组患者在性别、糖尿病、TC、LDL-C、纤维蛋白原以及美国国立卫生研究院卒中量表(NIHSS)评分等方面比较,差异均有统计学意义(P<0.05)。两组患者基底动脉狭窄程度比较,差异无统计学意义(P>0.05)。SDPI组患者大脑深部及幕下多发微出血发生率及数量分级均高于PPI组,差异均有统计学意义(P《0.05)。结论 SDPI患者幕下深部CMBs发生率高且数量多,其发病机制可能为小穿支动脉闭塞。

Objective To explore the cerebral microbleeds（ CMBs） between paramedian pontine infarction（ PPI） and small deep pontine Infarction（ SDPI） two different types of pontine infarction and investigate the possible etiopathogenesis under two different types of pontine infarction. Methods A retrospective study was performed on 442 patients with pontine infarction who were admitted from October 2012 to June 2016. According to inclusion and exclusion criteria,110 cases of isolated unilateral pontine infarction were enrolled.There were 70 PPI cases（ PPI group） and 40 SDPI cases（ SDPI group）. All the patients admitted in 24 hours were inspected urea,creatinine,cystatin C,total protein,albumin,total cholesterol（ TC）,triacylglycerol（ TG）,low density lipoprotein cholesterol（ LDL-C）,high density lipoprotein cholesterol（ HDL-C）,lipoprotein a,homocysteine（ Hcy）,fibrinogen,D-dimer,fasting blood-glucose（ FBG）,random blood glucose,high-sensitivity C-reactive protein（ h CRP）,added with cerebral magnetic resonance imaging（ MRI） combined with cerebral diffusion-weighted imaging（ DWI）,magnetic resonance angiography（ MRA） and susceptibility weighted imaging（ SWI）,CMBs occurrence were observed. Results Two groups of patients in the gender,diabetes,TC,LDL-C,fibrinogen,and NIHSS scores had statistically significant difference（ P〈0. 05）. Compared two groups of patients with basilar artery stenosis degree,there was no statistically significant difference（ P〈0. 05）. SDPI group of patients with deep brain and curtain more bleeding incidence and quantity grading were higher than that in PPI group,and the difference had statistical significance（ P〈0. 05）. Conclusion The occurence rate and numbers of deep subtentorial multiple CMBs in SDPI patients are high,and its pathogenesis may be little perforators artery occlusion.